Intravitreal Cidofovir Treatment for Chronic Glaucoma in a Non-visual, Painful EyeJune 23, 2017

Ophthalmology Notes

Intravitreal Cidofovir Treatment for Chronic Glaucoma in a Non-visual, Painful Eye

Written by Petra A. Lackner, DVM, DACVO

Meet Gin, She is an 11 year old Great Pyrenees sweetheart

Meet Gin, She is an 11 year old Great Pyrenees sweetheart

Gin is an almost 11 year old Great Pyrenees. She had been adopted from Tennessee a few months prior to presentation at Capital District. In recent weeks her right eye was cloudy and seemed swollen. Gin’s new owner noticed that she was sleeping a lot more and was generally listless.

Examination and Findings

Gin presented for an ophthalmology consultation. Examination revealed an absent menace in the right eye as well as buphthalmos.  Nuclear sclerosis of the lens was noted OU with a cupped optic nerve OD. Her Schirmer Tear test was within normal limits and the eyes did not take up fluorescein stain.

The intraocular pressure in the right eye measured at 58 mm Hg and the left eye was 17 mm Hg. This was consistent with a diagnosis of chronic glaucoma.

Treatment

Glaucoma in dogs can be primary or secondary. In the absence of other intraocular abnormalities (lens luxation, iridal masses, adhesions) this glaucoma was presumptively diagnosed as primary glaucoma.

Treatment options for Gin included:

  • Enucleation of the right eye
  • Evisceration with placement of an intraocular prosthesis
  • Intravitreal chemical cycloablation (Cidofovir or Vistide injection).

Gin’s owner wanted to avoid general anesthesia and wanted a solution which would relieve Gin’s discomfort immediately; she therefore opted for the intravitreal injection.

After aseptic preparation and topical anesthesia with Proparacaine, an aqueocentesis of the right eye was performed to an intraocular pressure of 10 mm Hg. Following this 375 micrograms or 0.1ml of diluted Cidofovir was injected intravitreally.

Gin was discharged immediately after the procedure with instructions to administer topical Neopolydex ointment OD TID and Timolol maleate 0.5% drops in the left eye once daily prophylactically.

Gin was rechecked two weeks later. The owner reported Gin was much more comfortable. Tonometry at this time showed an intraocular pressure less than 4 mm Hg OD and 8 mm Hg OS.

Outcome

Gin presented 2 months later. She was doing well at home. Tonometry in the right eye showed an IOP=3 mm Hg and the left eye was 12 mm Hg.  She is very happy in her follow up picture (above) and will continue to be rechecked every 3-4 months to monitor any changes in the left eye. Gin’s owner is very happy with the cosmetic result. Can you tell which eye had the injection?

In contrast to chemical ablation with Gentamycin, use of Cidofovir utilizes a much smaller volume of fluid for intravitreal injection and has a more cosmetic result (reduced phthisis and cataract formation).

About the Author

Petra A. Lackner, DVM, DACVO

Petra Lackner, DVM, DACVO, performing ophthalmic-surgeryDr. Petra Lackner received her Doctor of Veterinary Medicine Degree in 1991 from the University of Minnesota. She then completed a rotating internship in Small Animal Medicine and Surgery at the University of Pennsylvania Veterinary Hospital (VHUP).  Following this, Petra worked for 2 years as an emergency clinician in Baltimore. She then was awarded the IRTA Fellowship at the National Eye Institute in Bethesda MD where she was involved with research into Diabetic Retinopathy Models.

Dr. Lackner then started her comparative ophthalmology residency at the University of Zurich Tierspital. This was completed in 1998 with Board Certification following in 1999. From 1998 to 2001, Petra was one of the staff ophthalmologists at The Animal Medical Center in Manhattan, New York. She then moved to New Jersey and for the next 12 years worked at Garden State Veterinary Specialists in Tinton Falls, NJ.  She moved north to Massachusetts and provided Ophthalmology service in the Pioneer Valley for the next 5 years.

Dr. Lackner joined Capital District Veterinary Referral Hospital in November 2016 and is very excited to build an Ophthalmology Service in Latham, NY and the Capital Region.

In her spare time, Dr. Lackner likes to hike with her two Labrador Retrievers Sara and Attigus. She also enjoys reading, cooking various types of cuisine, biking and horseback riding.

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